Injection drug use (IDU) is a major public health problem that is associated with a host of medical complications, including blood-borne viral disease (e.g., HIV, Hepatitis C) and bacterial infections (e.g., skin abscesses, endocarditis), that often result from high-risk drug injection practices. There are no current interventions designed to reduce bacterial infections among IDUs, despite approximately 32% of IDUs reporting a current infection and almost 70% reporting a lifetime prevalence. The long-term objective of this program of research is to reduce high-risk injection practices among active IDUs that lead to bacterial and viral infections by developing and establishing the efficacy of an intervention that combines psychoeducation, skill-building, and motivational interviewing. In the first phase of the study, we will conduct focus group interviews with 16 IDUs in order to determine key areas of emphasis for an intervention with this population. We will then develop an infection-control intervention for active IDUs, pilot the intervention with 5 new participants in an open trial, and elicit their feedback regarding the intervention. Following refinement of the intervention, we will conduct a small randomized controlled trial (n = 60;30 in each arm) to examine the efficacy of the intervention compared to an assessment-only condition. We expect that participants randomized to the intervention will improve skin and needle cleaning behavioral skills and reduce high-risk injection practices for bacterial and viral infections. In addition, we will examine the acceptability and feasibility of the intervention to participants at all phases. This intervention will help to reduce the acquisition of bacterial infections and viral disease among IDUs, thus improving health outcomes for this population and reducing health care costs. PUBLIC HEALTH RELEVANCE: Viral and bacterial infections are a major problem among injection drug users, and contribute to costly emergency department utilization, hospitalization, and morbidity. The goal of this Stage I treatment development project is to develop and test the initial feasibility, acceptability, and efficacy of a skin and needle hygiene intervention for IDUs. The long-term objective of this program of research is to develop effective infection prevention programs that incorporate components of the Information-Motivation-Behavioral Skills theoretical model.